How to Leverage Patient Satisfaction

Compensation for rheumatologists and other physicians is increasingly tied to how satisfied patients are with the care they’ve received, given the Centers for Medicare and Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and other burgeoning programs. Leah Binder, president and chief executive of Washington, D.C.-based Leapfrog Group, says she only sees that trend continuing. She recently spoke to The Rheumatologist about her views.

Question: HCAHPS is a program that directly ties payments under Medicare to hospital performance as it relates to patient satisfaction. Is that the only way the two areas intersect?
Answer: There are lots of indirect ties now that didn’t used to exist, and I think that’s an area in which we’re seeing a lot of attention. … For example, if people do not understand what the true [meaning of the] instructions for their medications are when they’re discharged, they are often readmitted because they are not taking their medications adequately. If they don’t feel like they had good communication with their physician or nurses while they were in the hospital, that’s correlated with readmission. So patient engagement is … not a direct tie to readmission, but it’s a clear indirect link that hospitals are paying a lot of attention to.

Leah Binder

Some of [the indirect ties] are under the [rheumatologist’s] control. Another indirect link between reimbursement and patient satisfaction is market share because—and this is particularly true for physicians in practice—nowadays there has been a significant shift among the commercially insured population toward high deductible health plans. The numbers are pretty astounding. Many companies have moved to 100% high deductible plans. … So more patients are paying for the bill out of their own pocket, and their satisfaction is going to be directly tied to the payment of those bills. When you pay your own bill, when you actually pay for a service, you tend to be more sensitive to understanding what you are getting for that service.

Q: Often, you’ll hear concern from rheumatologists and others that a dissatisfied patient is not necessarily a patient that wasn’t incredibly well taken care of. How is a rheumatologist supposed to run that middle?
A: One of the toughest things that any industry has to grapple with is, how do you create a satisfied customer even though the customer may not always be right? You have to figure out a way to do it. And be willing to look at your practice with a critical eye and ask what you may have missed or whether you could do something differently. Or you need to say, ‘Well, some customers I just can’t satisfy, so I am not going to. I’ll take that risk.’ Then market to other kinds of customers. There are lots of different ways that other industries have grappled with this, but the bottom line is they lean toward listening to the customer to preserve market share.

Q: Do you expect more direct ties between compensation and satisfaction moving forward?
A: When we look at the [Affordable Care Act] and some of the programs I just mentioned that are directly or indirectly tied to patient satisfaction, we are going to see those programs expand. … In addition, the commercial marketplace is following suit, so there’s now an increasing interest by health plans and purchasers in how they can tie their own payments to performance [based] on patient satisfaction. There is a lot of interest in doing that. There’s a lot of interest in patient-reported outcomes, as well as just patient reports of their experience as being something that payers should be cognizant of when they have contracts with providers, so I think we are going to see that expand.

Q: As you said, there is no going back. What’s the takeaway for how to handle this dynamic moving forward?
A: It’s important for providers to ask the right questions. I think a lot of providers assume that their patients are really happy with them, and everything’s fine, and they communicate just fine and patients understand what they’re talking about. … But, in fact, asking questions and learning how to probe can reveal issues that the patient might otherwise be hesitant to tell you. By learning those [issues] on site and right in the presence of that patient, you will improve your relationship with the patient and probably improve your practice enormously.

Richard Quinn is a freelance writer in New Jersey.